A myriad of pressing issues continues to confront women in health care, including a renewed battle over abortion rights and access to RU-486 (Charo, 1991), disparate treatment of women in medical management of illness (Steingart et al., 1991), violence against women as a public health threat (American Medical Association, 1992), the growing population of women infected with HIV (United Nations Development Programme, 1993), and complex questions surrounding the maternal-fetal relationship, fetal diagnosis, and the control of pregnant women (Rothman, 1987; Mattingly, 1992). Despite these continuing concerns and problems, however, there is no doubt that women have become a viable, forceful interest group, challenging sexism in medical practice and research and calling attention to medical problems unique to women.

Gays and Lesbians: A New Activism

Gay rights, like minority and women's rights, have long been a part of U.S. political debate, but gays and lesbians emerged as a powerful, distinct interest group in the 1970s. The Stonewall riots in New York City in 1969, following a police raid on a gay bar in Greenwich Village, led to a decade of organizing, fundraising, and consciousness-raising among gays and lesbians throughout the country, modeled on the civil rights and feminist movements. The late 1970s saw renewed efforts in reaction to a backlash that resulted in the repeal of gay rights ordinances in Dade County, Florida, and other cities. In 1978, riots broke out in San Francisco after Dan White, the killer of gay supervisor Harvey Milk and mayor George Moscone, received a sentence of only seven years in prison (D'Emilio, 1983; Cruikshank, 1992).

As with minorities and women, the history of the gay community's relation with the U.S. medical establishment is characterized by suspicion and distrust (see background paper by Bayer). A decade before the AIDS epidemic, gay men began to form their own health clinics in response to perceived discriminatory treatment for sexually transmitted diseases. The American Psychiatric Association classified homosexuality as a mental illness until 1976; but even until 1990, the Public Health Service was responsible for enforcing a ban on immigration by homosexuals based on that mental classification (Levi, 1991). But as with other rights movements, the gay liberation movement focused its initial energies not on health issues, but on legal and social stigmatization and discrimination in housing, jobs, and other areas.

In the early 1980s, the general public's erroneous perception that AIDS was a disease affecting only gay men lent momentum to gay activism. The labeling of AIDS as a "gay" disease transformed what should have been a mass mobilization of public health resources to combat a critical health



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